Neck — MCQs

An abscess was surgically removed in a 26-year-old man from the middle of the posterior triangle on the right side. During recovery, the patient noticed that her shoulder drooped and she could no longer raise her right hand above her head to brush her hair. Which nerve was accidentally cut during the surgery?

Q160Easy

Which of the following structures does NOT drain into the submental lymph nodes?

Neck Indian Medical PG Practice Questions and MCQs

Question 151: Which of the following features about the thyroid gland is TRUE?

A. Normal thyroid gland weighs 12-20 grams. (Correct Answer)
B. The thyroid gland is poorly vascular.
C. The thyroid gland has a firm consistency.
D. Four parathyroid glands are located laterally and posteriorly to the thyroid gland.

Explanation: ### Explanation **1. Why Option A is Correct:** The thyroid gland is the largest endocrine gland in the body. In a healthy adult, its weight typically ranges between **12 to 20 grams** (though some textbooks cite up to 25g). It is slightly heavier in females and can enlarge during menstruation and pregnancy. **2. Why the Other Options are Incorrect:** * **Option B:** The thyroid gland is **highly vascular**, not poorly vascular [1]. It receives its blood supply from the superior and inferior thyroid arteries (and occasionally the thyroidea ima). The blood flow rate to the thyroid is remarkably high, comparable to that of the kidneys [1]. * **Option C:** A normal thyroid gland has a **soft consistency**. A "firm" or "hard" consistency is usually pathological, seen in conditions like Riedel’s thyroiditis, medullary carcinoma, or advanced multinodular goiter. * **Option D:** While there are typically four parathyroid glands, they are located on the **posterior border** of the thyroid lobes, specifically within the **surgical capsule** [2]. They are not described as being "lateral" to the gland; rather, they are medial to the recurrent laryngeal nerve or embedded in the posterior surface of the thyroid [2]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Capsules:** The thyroid has two capsules. The **true capsule** is formed by peripheral condensation of thyroid connective tissue. The **false capsule** is derived from the **pretracheal fascia** [3]. * **Venous Plexus:** The venous plexus lies *between* the true and false capsules. Therefore, during thyroidectomy, the gland is removed along with the true capsule to avoid massive hemorrhage. * **Suspensory Ligament of Berry:** This condensation of pretracheal fascia attaches the thyroid to the cricoid cartilage. This is why the thyroid moves upward during deglutition (swallowing). * **Nerve Relations:** The **External Laryngeal Nerve** is closely related to the Superior Thyroid Artery, while the **Recurrent Laryngeal Nerve** is related to the Inferior Thyroid Artery.

Question 152: Which of the following nerves is involved in the opening of the laryngeal inlet?

A. Recurrent laryngeal nerve (Correct Answer)
B. External laryngeal nerve
C. Internal laryngeal nerve
D. Superficial laryngeal nerve

Explanation: The laryngeal inlet is controlled by the intrinsic muscles of the larynx, which regulate the opening and closing of the airway. ### **Explanation of the Correct Answer** The **Recurrent Laryngeal Nerve (RLN)** is the correct answer because it provides motor innervation to almost all intrinsic muscles of the larynx [1]. Specifically, the opening of the laryngeal inlet is primarily mediated by the **Thyroepiglottic muscle**, which widens the inlet. Conversely, the inlet is closed by the Aryepiglottic and Oblique arytenoid muscles. Since the RLN supplies all intrinsic muscles except the Cricothyroid, it is the nerve responsible for the motor action of opening the inlet [1]. ### **Analysis of Incorrect Options** * **External Laryngeal Nerve:** This nerve supplies only the **Cricothyroid muscle** (the "tenser" of the vocal cords). It does not control the muscles that open or close the laryngeal inlet. * **Internal Laryngeal Nerve:** This is a purely **sensory** nerve. It provides sensory innervation to the laryngeal mucosa above the level of the vocal folds. It has no motor function. * **Superficial Laryngeal Nerve:** This is not a standard anatomical term in this context. The Superior Laryngeal Nerve (which divides into Internal and External branches) is likely what was intended, but it does not directly open the inlet. ### **NEET-PG High-Yield Pearls** * **Safety Muscle of Larynx:** The **Posterior Cricoarytenoid** is the only abductor of the vocal cords (opens the glottis) and is supplied by the RLN. * **Sensory Supply:** Above vocal cords = Internal Laryngeal Nerve; Below vocal cords = Recurrent Laryngeal Nerve. * **Nerve Injury:** Unilateral RLN injury leads to hoarseness; bilateral injury can lead to inspiratory stridor and airway obstruction [1].

Question 153: Which of the following laryngeal cartilages is hyaline?

A. Epiglottis
B. Corniculate
C. Cricoid (Correct Answer)
D. Cuneiform

Explanation: ### Explanation The laryngeal skeleton consists of nine cartilages: three single (Thyroid, Cricoid, Epiglottis) and three paired (Arytenoid, Corniculate, Cuneiform). These are histologically classified into **Hyaline** and **Elastic** types. **Why Cricoid is Correct:** The **Cricoid**, **Thyroid**, and the **greater part of the Arytenoid** cartilages are composed of **Hyaline cartilage**. Hyaline cartilage is characterized by a collagen-rich matrix that has a tendency to **calcify and ossify** with advancing age (usually after 25–30 years). This is a high-yield point for radiology, as these cartilages become visible on X-rays in older patients. **Why the Other Options are Incorrect:** * **A. Epiglottis:** This is composed of **Elastic cartilage**. Elastic cartilage contains elastic fibers, providing flexibility to prevent airway obstruction during swallowing. Unlike hyaline cartilage, it **never calcifies**. * **B. Corniculate & D. Cuneiform:** These are small, paired cartilages located within the aryepiglottic folds. Both are composed of **Elastic cartilage**. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mnemonic for Elastic Cartilages:** Remember the **"3 Es and 2 Cs"**: **E**piglottis, **E**xternal Ear (Pinna), **E**ustachian tube, **C**orniculate, and **C**uneiform. 2. **Arytenoid Exception:** The base of the arytenoid is hyaline, but the **vocal process** and the **apex** are elastic. 3. **Cricoid Significance:** It is the only **complete cartilaginous ring** in the entire respiratory tract. It marks the level of **C6**, the junction of the larynx with the trachea, and the pharynx with the esophagus.

Question 154: Which part of the Internal Carotid Artery (ICA) does not give any branches?

A. Cervical (Correct Answer)
B. Petrous
C. Cavernous
D. Cerebral

Explanation: The Internal Carotid Artery (ICA) is divided into four segments: **Cervical, Petrous, Cavernous, and Cerebral.** ### Why Cervical is Correct The **Cervical part** of the ICA begins at the bifurcation of the Common Carotid Artery (at the level of the upper border of the thyroid cartilage) and ascends within the carotid sheath to the base of the skull. In the neck, it is unique because it **gives off no branches**. It enters the skull through the carotid canal to become the petrous part. ### Why Other Options are Incorrect * **Petrous Part:** Located within the carotid canal of the temporal bone. It gives off the **caroticotympanic arteries** (supplying the tympanic cavity) and the artery of the pterygoid canal. * **Cavernous Part:** Located within the cavernous sinus. It gives off the **cavernous branches** (to the trigeminal ganglion), the inferior hypophyseal artery, and the meningeal branch. * **Cerebral Part:** This part gives off several vital branches, including the **Ophthalmic artery**, Posterior communicating artery, Anterior choroidal artery, and its terminal branches (Anterior and Middle Cerebral arteries). ### NEET-PG High-Yield Pearls * **Carotid Triangle:** The ICA lies posterolateral to the External Carotid Artery (ECA) at its origin. * **Carotid Sinus:** Located at the commencement of the ICA, it acts as a baroreceptor (innervated by CN IX). * **Mnemonic for ICA segments:** **C**an **P**eter **C**ause **C**onfusion? (**C**ervical, **P**etrous, **C**avernous, **C**erebral). * **Clinical Note:** The absence of branches in the neck is a key surgical landmark to distinguish the ICA from the ECA (which has 8 branches in the neck).

Question 155: All of the following structures are located within the carotid sheath, EXCEPT:

A. Internal jugular vein
B. Cervical sympathetic trunk (Correct Answer)
C. Vagus nerve
D. Internal carotid artery

Explanation: ### Explanation The **carotid sheath** is a condensation of the deep cervical fascia (derived from the pretracheal, prevertebral, and investing layers) that extends from the base of the skull to the arch of the aorta. Understanding its contents is a frequent high-yield topic in NEET-PG. **Why the Cervical Sympathetic Trunk is the Correct Answer:** The cervical sympathetic trunk is **not** located inside the carotid sheath. Instead, it lies posterior to the sheath, embedded in the **prevertebral fascia**. This is a common "trap" question because of the trunk's close anatomical proximity to the posterior wall of the sheath. **Analysis of Incorrect Options (Contents of the Sheath):** * **Internal Jugular Vein (A):** Located laterally within the sheath. * **Internal Carotid Artery (D):** Located medially in the upper part of the sheath (the Common Carotid Artery occupies the medial position in the lower part). * **Vagus Nerve (C):** Located posteriorly in the groove between the artery and the vein [1]. **NEET-PG High-Yield Pearls:** 1. **Ansa Cervicalis:** The superior belly of the ansa cervicalis is often embedded in the **anterior wall** of the carotid sheath. 2. **Deep Cervical Lymph Nodes:** These are found along the internal jugular vein within the sheath. 3. **Clinical Correlation:** Infections in the "danger space" (behind the esophagus) can spread laterally into the carotid sheath, potentially leading to internal jugular vein thrombosis (Lemierre's syndrome). 4. **Mnemonic:** Remember the contents as **"I See 10 CCs"** (IJV, Common Carotid, CN 10/Vagus).

Question 156: Erb's point is located at the junction of which two cervical vertebrae?

A. C5 and C6 (Correct Answer)
B. C6 and C7
C. C7 and C8
D. C8 and T1

Explanation: ### Explanation **1. Why C5 and C6 is the Correct Answer:** Erb’s point (also known as the "nerve point of the neck") in the context of the brachial plexus refers to the specific site where six nerves meet. It is formed by the union of the **C5 and C6 nerve roots**, which together form the **Upper Trunk** of the brachial plexus. At this precise anatomical junction, the nerve fibers diverge into four branches: the nerve to the subclavius, the suprascapular nerve, and the anterior and posterior divisions of the upper trunk. Because this area is a focal point for multiple neural pathways, it is highly susceptible to traction injuries. **2. Why Other Options are Incorrect:** * **C6 and C7:** While C7 forms the Middle Trunk, there is no major "point" or junction equivalent to Erb's point at this level. * **C7 and C8:** These roots do not unite; C7 continues as the middle trunk, while C8 joins T1. * **C8 and T1:** The union of these two roots forms the **Lower Trunk**. Injury to this junction results in **Klumpke’s Paralysis**, characterized by a "claw hand" deformity, rather than Erb's palsy. **3. Clinical Pearls for NEET-PG:** * **Erb’s Palsy:** Caused by an increase in the angle between the head and shoulder (e.g., birth trauma or falling on the shoulder). * **Deformity:** Results in **"Policeman’s Tip Hand"** or **"Waiter’s Tip Hand"** (arm adducted, medially rotated, forearm extended and pronated). * **Nerves involved:** Primarily affects the Axillary nerve, Suprascapular nerve, and Musculocutaneous nerve. * **Muscles paralyzed:** Biceps brachii, Brachialis, Deltoid, Supraspinatus, Infraspinatus, and Brachioradialis.

Question 157: Which of the following is NOT true regarding the recurrent laryngeal nerve?

A. It supplies some intrinsic muscles of the larynx.
B. It supplies the inferior constrictor muscle.
C. It carries sensation from below the vocal cords.
D. It carries sensation from the anterior two-thirds of the tongue. (Correct Answer)

Explanation: Explanation: The **Recurrent Laryngeal Nerve (RLN)** is a branch of the Vagus nerve (CN X) and is the primary motor nerve of the larynx. **Why Option D is the correct answer:** Sensation from the **anterior two-thirds of the tongue** is carried by two different nerves: the **Lingual nerve** (branch of V3) for general sensation (touch/pain) and the **Chorda tympani** (branch of CN VII) for special sensation (taste). The RLN has no role in the innervation of the tongue. **Analysis of other options:** * **Option A:** The RLN supplies **all intrinsic muscles of the larynx** except for the cricothyroid muscle (which is supplied by the external laryngeal nerve). * **Option B:** The RLN, along with the external laryngeal nerve and pharyngeal plexus, contributes to the motor supply of the **inferior constrictor muscle** (specifically the cricopharyngeus part). * **Option C:** The RLN provides sensory innervation to the laryngeal mucosa **below the level of the vocal cords**. (The internal laryngeal nerve supplies the mucosa above the vocal cords). **High-Yield Clinical Pearls for NEET-PG:** * **Course Asymmetry:** The right RLN hooks around the **subclavian artery**, while the left RLN hooks around the **arch of aorta** (ligamentum arteriosum) [1]. * **Thyroid Surgery:** The RLN is most vulnerable to injury during thyroidectomy near the **inferior thyroid artery** [1]. * **Clinical Sign:** Unilateral RLN injury leads to hoarseness of voice; bilateral injury can cause respiratory distress (stridor) due to the vocal cords assuming a paramedian position [1].

Question 158: The anterior triangle of the neck is bounded anteriorly by which landmark?

A. The anterior median line of the neck extending from the symphysis menti to the suprasternal notch. (Correct Answer)
B. The midline of the neck.
C. The midline of the neck up to the sternoclavicular joint.
D. The posterior border of the thyroid gland.

Explanation: **Explanation:** The **Anterior Triangle** of the neck is a critical anatomical region defined by specific musculoskeletal boundaries. To understand the correct answer, one must visualize the triangle’s three primary borders: 1. **Anteriorly:** The anterior median line of the neck (extending from the symphysis menti to the suprasternal notch). 2. **Posteriorly:** The anterior border of the Sternocleidomastoid muscle. 3. **Superiorly (Base):** The lower border of the body of the mandible and a line extending from the angle of the mandible to the mastoid process. **Option A** is the most accurate because it provides the precise anatomical landmarks (symphysis menti to suprasternal notch) that define the vertical midline. **Why other options are incorrect:** * **Option B:** While "midline" is colloquially used, it lacks the anatomical precision required for surgical and academic descriptions. * **Option C:** The midline does not end at the sternoclavicular joint; the triangle terminates at the **suprasternal notch** (manubrium). * **Option D:** The posterior border of the thyroid gland is a deep structure and does not form the superficial boundary of the anterior triangle. **High-Yield Clinical Pearls for NEET-PG:** * **Sub-divisions:** The anterior triangle is further divided into the **Submental, Digastric (Submandibular), Carotid, and Muscular triangles** by the digastric and omohyoid muscles. * **The Carotid Triangle:** This is the most clinically significant subdivision, containing the common carotid artery, internal jugular vein, and the vagus nerve (Carotid Sheath). * **Roof:** Formed by the investing layer of deep cervical fascia. * **Floor:** Formed by the pharynx, larynx, and thyroid gland.

Question 159: An abscess was surgically removed in a 26-year-old man from the middle of the posterior triangle on the right side. During recovery, the patient noticed that her shoulder drooped and she could no longer raise her right hand above her head to brush her hair. Which nerve was accidentally cut during the surgery?

A. Accessory (XI) (Correct Answer)
B. Ansa Cervicalis
C. Facial (VII)
D. Hypoglossal (XII)

Explanation: The patient is presenting with a classic injury to the **Spinal Accessory Nerve (CN XI)**. **Why the correct answer is right:** The Spinal Accessory Nerve emerges from the posterior border of the Sternocleidomastoid (SCM) muscle and crosses the **posterior triangle** of the neck superficially, making it highly vulnerable to injury during minor surgical procedures like lymph node biopsies or abscess drainage. * **Anatomical Course:** It lies just beneath the investing layer of deep cervical fascia. * **Clinical Presentation:** It innervates the **Trapezius** muscle. Paralysis of the Trapezius leads to: 1. **Shoulder drooping** (loss of muscle tone). 2. **Inability to abduct the arm above 90 degrees** (the Trapezius is essential for rotating the scapula upward to allow overhead movement). **Why the incorrect options are wrong:** * **Ansa Cervicalis:** Innervates the infrahyoid (strap) muscles. Injury would cause difficulty in stabilizing the hyoid bone but no shoulder deficits. * **Facial Nerve (VII):** Innervates muscles of facial expression. Injury would lead to facial drooping (Bell’s palsy), not shoulder weakness. * **Hypoglossal Nerve (XII):** Innervates the muscles of the tongue. Injury leads to deviation of the tongue toward the side of the lesion. **High-Yield NEET-PG Pearls:** * The Spinal Accessory Nerve is the only cranial nerve that **does not** arise from the brainstem (its roots arise from C1-C5 spinal segments). * It enters the skull through the **Foramen Magnum** and exits through the **Jugular Foramen**. * **Erb’s Point:** The nerve emerges at the posterior border of the SCM, roughly at the junction of the upper 1/3rd and middle 1/3rd of the muscle. * To test CN XI: Ask the patient to shrug their shoulders (Trapezius) and turn their head against resistance (SCM).

Question 160: Which of the following structures does NOT drain into the submental lymph nodes?

A. Anterior palate (Correct Answer)
B. Tip of tongue
C. Floor of mouth
D. Lower lip

Explanation: The **submental lymph nodes** are located in the submental triangle, between the anterior bellies of the digastric muscles. They serve as the primary drainage site for structures located in the central, anterior-most portion of the oral cavity and face. ### **Why "Anterior Palate" is the Correct Answer** The **Anterior Palate** (including the hard palate and maxillary gingiva) drains primarily into the **submandibular lymph nodes** or directly into the **upper deep cervical nodes**. It does not drain into the submental nodes because it is a superior structure, and its lymphatic channels follow the course of the facial and palatine vessels toward the submandibular region. ### **Analysis of Incorrect Options** * **Tip of the Tongue:** Lymphatics from the tip of the tongue pierce the mylohyoid muscle to drain directly into the submental nodes. (Note: The lateral margins drain to submandibular nodes, and the posterior third drains to deep cervical nodes). * **Floor of the Mouth:** The anterior part of the floor of the mouth (near the midline) drains into the submental nodes. * **Lower Lip:** Only the **central part** of the lower lip drains into the submental nodes. The lateral parts of the lower lip and the entire upper lip drain into the submandibular nodes. ### **High-Yield Clinical Pearls for NEET-PG** * **The "Central" Rule:** Submental nodes drain the "central" structures: Tip of tongue, central lower lip, floor of mouth, and mandibular incisors. * **Lip Cancer Spread:** Squamous cell carcinoma of the central lower lip first metastasizes to submental nodes, whereas lateral lip cancer spreads to submandibular nodes. * **Tongue Drainage:** The tongue has a complex drainage pattern. Remember: **Tip** → Submental; **Lateral** → Submandibular; **Posterior 1/3** → Deep Cervical (Jugulo-omohyoid). * **Efferent Path:** Submental nodes eventually drain into the **submandibular** and **jugulo-omohyoid** nodes.

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Cervical Fascia

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Triangles of the Neck

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Deep Structures of the Neck

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Thyroid and Parathyroid Glands

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Vasculature of the Neck

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Lymphatic Drainage

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Cervical Plexus

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Root of the Neck

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Applied Anatomy and Clinical Correlations

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Surface Anatomy of the Neck

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